Using full probability models to compute probabilities of actual interest to decision makers.

Harrell FE, Shih YC
Int J Technol Assess Health Care. 2001 17 (1): 17-26

PMID: 11329842 · DOI:10.1017/s0266462301104034

The objective of this paper is to illustrate the advantages of the Bayesian approach in quantifying, presenting, and reporting scientific evidence and in assisting decision making. Three basic components in the Bayesian framework are the prior distribution, likelihood function, and posterior distribution. The prior distribution describes analysts' belief a priori, the likelihood function captures how data modify the prior knowledge; and the posterior distribution synthesizes both prior and likelihood information. The Bayesian approach treats the parameters of interest as random variables, uses the entire posterior distribution to quantify the evidence, and reports evidence in a "probabilistic" manner. Two clinical examples are used to demonstrate the value of the Bayesian approach to decision makers. Using either an uninformative or a skeptical prior distribution, these examples show that the Bayesian methods allow calculations of probabilities that are usually of more interest to decision makers, e.g., the probability that treatment A is similar to treatment B, the probability that treatment A is at least 5% better than treatment B, and the probability that treatment A is not within the "similarity region" of treatment B, etc. In addition, the Bayesian approach can deal with multiple endpoints more easily than the classic approach. For example, if decision makers wish to examine mortality and cost jointly, the Bayesian method can report the probability that a treatment achieves at least 2% mortality reduction and less than $20,000 increase in costs. In conclusion, probabilities computed from the Bayesian approach provide more relevant information to decision makers and are easier to interpret.

MeSH Terms (14)

Arterial Occlusive Diseases Bayes Theorem Clinical Trials as Topic Coronary Disease Decision Making Evidence-Based Medicine Health Services Research Humans Models, Statistical Nifedipine Risk Assessment Thrombolytic Therapy Treatment Outcome Vasodilator Agents

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